Che Guevara :: On Revolutionary Medicine

August 19, 1960

By Ernesto Che Guevara

This simple celebration, another among the hundreds of public functions with which the Cuban people daily celebrate their liberty, the progress of all their revolutionary laws, and their advances along the road to complete independence, is of special interest to me.

Almost everyone knows that years ago I began my career as a doctor. And when I began as a doctor, when I began to study medicine, the majority of the concepts I have today, as a revolutionary, were absent from my store of ideals.

Like everyone, I wanted to succeed. I dreamed of becoming a famous medical research scientist; I dreamed of working indefatigably to discover something which would be used to help humanity, but which signified a personal triumph for me. I was, as we all are, a child of my environment.

After graduation, due to special circumstances and perhaps also to my character, I began to travel throughout America, and I became acquainted with all of it. Except for Haiti and Santo Domingo, I have visited, to some extent, all the other Latin American countries. Because of the circumstances in which I traveled, first as a student and later as a doctor, I came into close contact with poverty, hunger and disease; with the inability to treat a child because of lack of money; with the stupefaction provoked by the continual hunger and punishment, to the point that a father can accept the loss of a son as an unimportant accident, as occurs often in the downtrodden classes of our American homeland. And I began to realize at that time that there were things that were almost as important to me as becoming a famous or making a significant contribution to medical science: I wanted to help those people.

But I continued to be, as we all continue to be always, a child of my environment, and I wanted to help those people with my own personal efforts. I had already traveled a great deal - I was in Guatemala at the time, the Guatemala of Arbenz- and I had begun to make some notes to guide the conduct of the revolutionary doctor. I began to investigate what was needed to be a revolutionary doctor.

However, aggression broke out, the aggression unleaded by the United Fruit Company, the Department of State, Foster Dulles- in reality the same thing- and their puppet, called Castillo Armas. The aggression was successful, since the people had not achieved the level of maturity of the other Cuban people of today. One fine day, a day like any other, I took the road of exile, or at least, I took the road of flight from Guatemala, since that was not my country.

Then I realized a fundamental thing: For one to be a revolutionary doctor or to be a revolutionary at all, there must first be a revolution. Isolated individual endeavour, for all its purity of ideals, is of no use, and the desire to sacrifice an entire lifetime to the noblest of ideals serves no purpose if one works alone, solitarily, in some corner of America, fighting against adverse governments and social conditions which prevent progress. To create a revolution, one must have what there is in Cuba - the mobilization of a whole people, who learn by the use of arms and the exercise of militant unity to understand the value of arms and the value of unity.

And now we have come to the nucleus of the problem we have before us at this time. Today one finally has the right and even the duty to be, above all things, a revolutionary doctor, that is to say a man who utilizes the technical knowledge of his profession in the service of the revolution and the people. But now old questions reappear: How does one actually carry out a work of social welfare? How does one unite individual endeavour with the needs of society?

We must review again each of our lives, what we did and thought as doctors, or in any function of public health before the revolution. We must do this with profound critical zeal and arrive finally at the conclusion that almost everything we thought and felt in that past period ought to be deposited in an archive, and a new type of human being created. If each one of us expends his maximum effort towards the perfection of that new human type, it will be much easier for the people to create him and let him be the example of the new Cuba.

It is good that I emphasize for you, the inhabitants of Havana who are present here, this idea; in Cuba a new type of man is being created, whom we cannot fully appreciate here in the capital, but who is found in every corner of the country. Those of you who went to the Sierra Maestra on the twenty-sixth of July must have seen two completely unknown things. First, an army with hoes and pickaxes, an army whose greatest pride is to parade in the patriotic festivals of Oreinte with hoes and axes raised, while their military comrades march with rifles. But you must have seen something even more important. You must have seen children whose physical constitutions appeared to be those of eight or nine-year-olds, yet almost all of whom are thirteen or fourteen. They are the most authentic children of the Sierra Maestra, the most authentic offspring of hunger and misery. They are the creatures of malnutrition.

In this tiny Cuba, with its four or five television channels and hundred of radio stations, with all the advances of modern science, when those children arrived at school for the first time at night and saw the electric light bulbs, they exclaimed that the stars were very low that night. And those children, some of whom you must have seen, are learning in collective schools skills ranging from reading to trades, and even the very difficult science of becoming revolutionaries.

Those are the new humans being born in Cuba. They are being born in isolated areas, in different parts of the Sierra Maestra, and also in the cooperatives and work centres. All this has a lot to do with the theme of our talk today, the integration of the physician or any other medical worker, into the revolutionary movement. The task of educating and feeding youngsters, the task of educating the army, the task of distributing the lands of the former absentee landlords to those who laboured every day upon that same land without receiving its benefits, are accomplishments of social medicine which have been performed in Cuba.

The principle upon which the fight against disease should be based is the creation of a robust body; but not the creation of a robust body by the artistic work of a doctor upon a weak organism; rather, the creation of a robust body with the work of the whole collectivity, upon the entire social collectivity.

Some day, therefore, medicine will have to convert itself into a science that serves to prevent disease and orients the public toward carrying out its medical duties. Medicine should only intervene in cases of extreme urgency, to perform surgery or something else which lies outside the skills of the people of the new society we are creating.

The work that today is entrusted to the Ministry of Health and similar organizations is to provide public health services for the greatest possible number of persons, institute a program of preventive medicine, and orient the public to the performance of hygienic practices.

But for this task of organization, as for all the revolutionary tasks, fundamentally it is the individual who is needed. The revolution does not, as some claim, standardize the collective will and the collective initiative. On the contrary, it liberates man's individual talent. What the revolution does is orient that talent. And our task now is to orient the creative abilities of all medical professionals toward the tasks of social medicine.

We are at the end of an era, and not only here in Cuba. No matter what is hoped or said to the contrary, the form of capitalism we have known, in which we were raised, and under which we have suffered, is being defeated all over the world. The monopolies are being overthrown; collective science is coring new and important triumphs daily. In the Americas we have had the proud and devoted duty to be the vanguard of a movement of liberation which began a long time ago on the other subjugated continents, Africa and Asia. Such a profound social change demands equally profound changes in the mental structure of the people.

Individualism, in the form of the individual action of a person alone in a social milieu, must disappear in Cuba. In the future individualism ought to be the efficient utilization of the whole individual for the absolute benefit of a collectivity. It is not enough that this idea is understood today, that you all comprehend the things I am saying and are ready to think a little about the present and the past and what the future ought to be. In order to change a way of thinking, it is necessary to undergo profound internal changes and to witness profound external changes, especially in the performance of our duties and obligations to society.

Those external changes are happening in Cuba every day. One way of getting to know the Revolution and becoming aware of the energies held in reserve, so long asleep within the people, is to visit all Cuba and see the cooperatives and the work centres which are now being created. And one way of getting to the heart of the medical question is not only to visit and become acquainted with the people who make up these cooperatives and work centres, but to find out what diseases they have, what their sufferings are, what have been their chronic miseries for years, and what has been the inheritance of centuries of repression and total submission. The doctor, the medical worker, must go to the core of his new work, which is the man within the mass, the man within the collectivity.

Always, no matter what happens in the world, the doctor is extremely close to his patient and knows the innermost depths of his psyche. Because he is the one who attacks pain and mitigates it, he performs and invaluable labour of much responsibility in society.

A few months ago, here in Havana, it happened that a group of newly graduated doctors did not want to go into the country's rural areas, and demanded remuneration before they would agree to go. From the point of view of the past it is the most logical thing in the world for this to occur; at least, so it seems to me, for I can understand it perfectly. The situation brings back to me the memory of what I was and what I thought a few years ago. [My case is the] story all over again of the gladiator who rebels, the solitary fighter who wants to assure a better future, better conditions, and to make valid the need people have of him.

But what would have happened if instead of these boys, whose families generally were able to pay for their years of study, others of less fortunate means had just finished their schooling and were beginning the exercise of their profession? What would have occurred if two or three hundred peasants had emerged, let us say by magic, from the university halls?

What would have happened, simply, is that the peasants would have run, immediately and with unreserved enthusiasm, to help their brothers. They would have requested the most difficult and responsible jobs in order to demonstrate that the years of study they had received had not been given in vain. What would have happened is what will happen in six or seven years, when the new students, children of workers and peasants, receive professional degrees of all kinds.

But we must not view the future with fatalism and separate all men into either children of the working and peasant classes or counter-revolutionaries, because it is simplistic, because it is not true, and because there is nothing which educates an honorable man more than living in a revolution. None of us, none of the first group which arrived in the Granma, who settled in the Sierra Maestra, and learned to respect the peasant and the worker living with him, had a peasant or working-class background. Naturally, there were those who had had to work, who had known certain privations in childhood; but hunger, what is called real hunger, was something none of us had experienced. But we began to know it in the two long years in the Sierra Maestra. And then many things became very clear.

We, who at first punished severely anyone who touched the property of even a rich peasant or a landowner, brought ten thousand head of cattle to the Sierra one day and said to the peasants, simply, 'Eat'. And the peasants, for the first time in years and years, some for the first time in their lives, ate beef.

The respect which we had had for the sacrosanct property right to those ten thousand head of cattle was lost in the course of armed battle, and we understood perfectly that the life of a single human being is worth a million time more than all the property of the richest man on earth. And we learned it; we, who were not of the working class nor of the peasant class. And are we going to tell the four winds, we who were the privileged ones, that the rest of the people in Cuba cannot learn it also? Yes, they can learn it, and besides, the Revolution today demands that they learn it, demands that it be well understood that far more important than a good remuneration is the pride of serving one's neighbor; that much more definitive and much more lasting than all the gold that one can accumulate is the gratitude of a people. And each doctor, within the circle of his activities, can and must accumulate that valuable treasure, the gratitude of his people.

We must, then, begin to erase our old concepts and begin to draw closer and closer to the people and to be increasingly aware. We must approach them not as before. You are all going to say, 'No. I like the people. I love talking to workers and peasants, and I go here or there on Sundays to see such and such.' Everybody has done it. But we have done it practising charity, and what we have to practice today is solidarity. We should not go to the people and say, 'Here we are. We come to give you the charity of our presence, to teach you our science, to show you your errors, your lack of culture, your ignorance of elementary things.' We should go instead with an inquiring mind and a humble spirit to learn at that great source of wisdom that is the people.

Later we will realize many times how mistaken we were in concepts that were so familiar they became part of us and were an automatic part of our thinking. Often we need to change our concepts, not only the general concepts, the social or philosophical ones, but also sometimes, our medical concepts.

We shall see that diseases need not always be treated as they are in big-city hospitals. We shall see that the doctor has to be a farmer also and plant new foods and sow, by example, the desire to consume new foods, to diversify the Cuban nutritional structure, which is so limited, so poor, in one of the richest countries in the world, agriculturally and potentially. We shall see, then, how we shall have to be, in these circumstances, a bit pedagogical- at times very pedagogical. It will be necessary to be politicians, too, and the first thing we will have to do is not to go to the people to offer them our wisdom. We must go, rather, to demonstrate that we are going to learn with the people, that together we are going to carry out that great and beautiful common experiment: the construction of a new Cuba.

Many steps have already been taken. There is a distance that cannot be measured by conventional means between that first day of January in 1959 and today. The majority of the people understood a long time ago that not only a dictator had fallen here, but also a system. Now comes the part the people must learn, that upon the ruins of a decayed system we must build the new system which will bring about the absolute happiness of the people.

I remember that some time in the early months of last year comrade Guillên arrived from Argentina. He was the same great poet he is today, although perhaps his books had been translated into a language or two less, for he is gaining new readers every day in all languages of the world. But he was the same man he is today. However, it was difficult for Guillên to read his poems here, which were popular poetry, poetry of the people, because that was during the first epoch, the epoch of prejudices. And nobody ever stopped to think that for years and years, with unswerving dedication, the poet Guillên had placed all his extraordinary poetic gift at the service of the people and at the service of the cause in which he believed. People saw him, not as the glory of Cuba, but as the representative of a political party which was taboo.

Now all that has been forgotten. We have learned that there can be no divisions due to the different points of view of certain internal structures of our country if we have a common enemy and a common goal. What we have to agree upon is whether or not we have a common enemy and whether or not we are attempting to reach a common goal.

By now we have become convinced that there definitely is a common enemy. No one looks over his shoulder to see if there is anyone who might overhear- perhaps some agent from the embassy who would transmit the information- before giving an opinion against monopolies, before saying clearly, 'Our enemy, and the enemy of all America, is the monopolistic government of the United States of America.' If now everyone knows that is the enemy, and it is coming to be known also that anyone who fights against that enemy has something in common with us, then we come to the second part. Where and now, for Cuba, what are our goals? What do went want? Do we or do we not want the happiness of the people? Are we, or are we not fighting for the total economic liberation of Cuba?

Are we or are we not struggling to be a free nation among free nations, without belonging to any military bloc, without having to consult the embassy of any great power on earth about any internal or external measure that is going to be taken here? If we plan to redistribute wealth of those who have too much in order to give it to those who have nothing; if we intend to make creative work a daily, dynamic source of all our happiness, then we have goals toward which to work. And anyone who has the same goals is our friend. If he has other concepts besides, if he belongs to some organization or other, those are minor matters.

In moments of great danger, in moments of great tensions and great creations, what count are great enemies and great goals. If we are already agreed, if we all know now where we are going - and let him grieve to whom it will cause grief- then we have to begin our work.

I was telling you that to be a revolutionary you have first to have a revolution. We already have it. Next, you have to know the people with whom you are going to work. I think that we are not yet well acquainted, that we still have to travel a while on that road. You ask me what are the vehicles for getting to know the people beside the vehicle of living in the cooperatives and working in them. Not everyone can do this, and there are many places where the presence of a medical worker is very important. I would say that the revolutionary militias are one of the great manifestations of the solidarity of the Cuban people. Militias now give a new function to the doctor and prepare him for what was, until a short time ago, a sad and almost fatal reality for Cuba, namely, that we are going to be the victim of an armed attack of great breadth.

I ought to warn you that the doctor, in the function of soldier and revolutionary, should always be a doctor. You should not commit the same error which we committed in the Sierra. Or maybe it was not an error, but all the medical comrades of that period know about it. It seemed dishonorable to us to remain at the side of a wounded man or a sick one, and we looked for any way possible of grabbing a rifle and going to prove on the battlefront what we could do.

Now the conditions are different, and the new armies which are being formed to defend the country must be armies with different tactics. The doctor will have an enormous importance within the plan of the new army. He must continue being a doctor, which is one of the most beautiful tasks there is and one of the most important in a war. And not only the doctor, but also the nurses, laboratory technicians, all those who dedicate themselves to this very human profession, are of he utmost importance.

Although we know of latent danger and are preparing ourselves to repel the aggression which still exists in the atmosphere, we must stop thinking about it. If we make war preparations the centre of our concern, we will not be able to devote ourselves to creative work. All the work and all the capital invested in preparing for a military action is wasted work and wasted money. Unfortunately, we have to do it, because there are others who are preparing themselves. But it is- and I say this in all honesty, on my honour as a soldier- the truth is that the outgoing money which most saddens me as I watch it leave the vault of the National Bank is the money that is going to pay for some weapon.

Nevertheless, the militias have a function in peacetime; the militias should be, in populous centres, the tool which unifies the people. An extreme solidarity should be practiced, as I have been told it is practised in the militias of the doctors. In time of danger they should go immediately to solve the problems of the poor people of Cuba. But the militias offer also an opportunity to live together, joined and made equal by a uniform, with men of all social classes of Cuba.

If we medical workers- and permit me to use once again a title which I had forgotten some time ago- are successful, if we use this new weapon of solidarity, if we know the goals, know the enemy, and know the direction we have to take, then all that is left for us to know is the part of the way to be covered each day. And that part no one can show us; that part is the private journey of each individual. It is what he will do every day, what he will gather from his individual experience, and what he will give of himself in the exercise of his profession, dedicated to the well-being of the people.

Now that we have all the elements for our march toward the future, let us remember the advice of Martí. Although at this moment I am ignoring it, one should follow it constantly, "The best way of telling is doing." Let us march, then, toward Cuba's future.